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Fan Y, Si Z, Wang L, Zhang L. DYT- TOR1A dystonia: an update on pathogenesis and treatment. Front Neurosci 2023; 17:1216929. [PMID: 37638318 PMCID: PMC10448058 DOI: 10.3389/fnins.2023.1216929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
DYT-TOR1A dystonia is a neurological disorder characterized by involuntary muscle contractions and abnormal movements. It is a severe genetic form of dystonia caused by mutations in the TOR1A gene. TorsinA is a member of the AAA + family of adenosine triphosphatases (ATPases) involved in a variety of cellular functions, including protein folding, lipid metabolism, cytoskeletal organization, and nucleocytoskeletal coupling. Almost all patients with TOR1A-related dystonia harbor the same mutation, an in-frame GAG deletion (ΔGAG) in the last of its 5 exons. This recurrent variant results in the deletion of one of two tandem glutamic acid residues (i.e., E302/303) in a protein named torsinA [torsinA(△E)]. Although the mutation is hereditary, not all carriers will develop DYT-TOR1A dystonia, indicating the involvement of other factors in the disease process. The current understanding of the pathophysiology of DYT-TOR1A dystonia involves multiple factors, including abnormal protein folding, signaling between neurons and glial cells, and dysfunction of the protein quality control system. As there are currently no curative treatments for DYT-TOR1A dystonia, progress in research provides insight into its pathogenesis, leading to potential therapeutic and preventative strategies. This review summarizes the latest research advances in the pathogenesis, diagnosis, and treatment of DYT-TOR1A dystonia.
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Affiliation(s)
- Yuhang Fan
- Department of Neurology, the Second Hospital of Jilin University, Changchun, China
| | - Zhibo Si
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, China
| | - Linlin Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lei Zhang
- Department of Neurology, the Second Hospital of Jilin University, Changchun, China
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Dzhalagoniya IZ, Usova SV, Gamaleya AA, Tomskiy AA, Shaikh AG, Sedov AS. DYT1 dystonia: Neurophysiological properties of the pallidal activity. Parkinsonism Relat Disord 2023; 112:105447. [PMID: 37267819 DOI: 10.1016/j.parkreldis.2023.105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this paper is to find the differences in the physiology of the pallidal neurons in DYT1 and non-DYT1 dystonia. METHODS We performed microelectrode recording of the single unit activity in both segments of the globus pallidus during stereotactic implantation of electrodes for deep brain stimulation (DBS). RESULTS We found a reduced firing rate, reduced burst rate, and increased pause index in both pallidal segments in DYT1. Also, in DYT1 the activity in both pallidal segments was similar, but not so in non-DYT1. CONCLUSION The results suggest a common pathological focus for both pallidal segments, located in the striatum. We also speculate that strong striatal influence on GPi and GPe overrides other input sources to the pallidal nuclei causing similarity in neuronal activity. SIGNIFICANCE We found significant differences in neuronal activity between DYT1 and non-DYT1 neurons. Our findings shed light on the pathophysiology of DYT-1 dystonia which can be very different from non-DYT1 dystonia and have other efficient treatment tactics.
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Affiliation(s)
- Indiko Z Dzhalagoniya
- N.N. Semenov Federal Research Center for Chemical Physics Russian Academy of Sciences, Novatorov st. 7A-1, Moscow, Russian Federation.
| | - Svetlana V Usova
- N.N. Semenov Federal Research Center for Chemical Physics Russian Academy of Sciences, Novatorov st. 7A-1, Moscow, Russian Federation
| | - Anna A Gamaleya
- N.N. Burdenko National Medical Research Center for Neurosurgery, 4th Tverskaya-Yamskaya st. 16, Moscow, Russian Federation
| | - Alexey A Tomskiy
- N.N. Burdenko National Medical Research Center for Neurosurgery, 4th Tverskaya-Yamskaya st. 16, Moscow, Russian Federation
| | - Aasef G Shaikh
- Department of Neurology, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA; Daroff-DelOsso Ocular Motility Laboratory, Neurology Service, Louis Stoke VA Medical Center, 10701 East Blvd, Cleveland, OH, USA
| | - Alexey S Sedov
- N.N. Semenov Federal Research Center for Chemical Physics Russian Academy of Sciences, Novatorov st. 7A-1, Moscow, Russian Federation; Moscow Institute of Physics and Technology, 9 Institutskiy per., Dolgoprudny, Moscow Region, Russian Federation
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Alkarras M, Nabeeh A, El Molla S, El Gayar A, Fayed ZY, Ghany WA, Raslan AM. Evaluation of outcome of different neurosurgical modalities in management of cervical dystonia. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Cervical dystonia is the most common form of focal dystonia and is managed by multiple modalities including repeated botulinum toxin injections, in addition to medical treatment with anticholinergics, muscle relaxants, and physiotherapy. However, surgical interventions could be beneficial in otherwise refractory patients. This study aims to report our experience in the neurosurgical management of cervical dystonia and evaluate patient outcomes using reliable outcome scores for the assessment of patients with cervical dystonia and possible complications. This case series study was conducted on 19 patients with cervical dystonia of different etiologies who underwent surgical management [ten patients underwent selective peripheral denervation, five patients underwent pallidotomy, and four patients underwent bilateral globus pallidus internus (GPi) deep brain stimulation (DBS)] in the period between July 2018 and June 2021 at Ain Shams University Hospitals, Cairo, Egypt. With the assessment of surgical outcomes using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Tsui scale 6 months postoperatively.
Results
Surgical management of patients with cervical dystonia of either primary or secondary etiology was associated with significant improvement in head and neck postures after 6 months without major complications associated with the different surgical procedures. The mean improvement in total TWSTRS and Tsui scores were 51.2% and 64.8%, respectively, compared with preoperative scores, while the mean improvement in the TWSTRS subscales (severity, disability, and pain) were 40.2%, 66.9%, and 58.3%, respectively.
Conclusion
Cervical dystonia patients in whom non-surgical options have failed to alleviate their symptoms can be managed surgically leading to significant improvements with minimal adverse effects. However, surgical treatment should be tailored according to several factors including but not limited to the etiology, pattern of dystonic activity, and comorbidities. Therefore, management should be tailored to achieve long-term improvement with minimal risk of complications.
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Neurophysiological Basis of Deep Brain Stimulation and Botulinum Neurotoxin Injection for Treating Oromandibular Dystonia. Toxins (Basel) 2022; 14:toxins14110751. [PMID: 36356002 PMCID: PMC9694803 DOI: 10.3390/toxins14110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Oromandibular dystonia (OMD) induces severe motor impairments, such as masticatory disturbances, dysphagia, and dysarthria, resulting in a serious decline in quality of life. Non-invasive brain-imaging techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) are powerful approaches that can elucidate human cortical activity with high temporal resolution. Previous studies with EEG and MEG have revealed that movements in the stomatognathic system are regulated by the bilateral central cortex. Recently, in addition to the standard therapy of botulinum neurotoxin (BoNT) injection into the affected muscles, bilateral deep brain stimulation (DBS) has been applied for the treatment of OMD. However, some patients' OMD symptoms do not improve sufficiently after DBS, and they require additional BoNT therapy. In this review, we provide an overview of the unique central spatiotemporal processing mechanisms in these regions in the bilateral cortex using EEG and MEG, as they relate to the sensorimotor functions of the stomatognathic system. Increased knowledge regarding the neurophysiological underpinnings of the stomatognathic system will improve our understanding of OMD and other movement disorders, as well as aid the development of potential novel approaches such as combination treatment with BoNT injection and DBS or non-invasive cortical current stimulation therapies.
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Angane A, Anvekar A, Keshari P, Unnithan V. Neuroleptic-induced tardive dystonia in young patients suffering from psychosis. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_10_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fu XX, Cai HY, Jiang H, Han S. Combined treatment with C16 peptide and angiopoietin-1 confers neuroprotection and reduces inflammation in 3-nitropropionic acid-induced dystonia mice. Aging (Albany NY) 2021; 13:19048-19063. [PMID: 34326273 PMCID: PMC8351673 DOI: 10.18632/aging.203354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Dystonia is a disorder associated with abnormalities in many brain regions including the basal ganglia and cerebellum. The toxin 3-Nitropropionic acid (3-NP) can induce neuropathologies in the mice striatum and nigra substance, including excitotoxicity, neuroinflammation, and extensive neuronal atrophy, characterized by progressive motor dysfunction, dystonia, and memory loss, mimicking those observed in humans. We established a mouse model of dystonia by administering 3-NP. Given the reported neuroprotective effects of the endothelial growth factor angiopoietin-1 (Ang-1) and the anti-inflammatory integrin αvβ3 binding peptide C16, we performed this study to evaluate their combined effects on 3-NP striatal toxicity and their therapeutic potential with multiple methods using an in vivo mouse model. Sixty mice were equally and randomly divided into three groups: control, 3-NP treatment, and 3-NP+C16+Ang-1 treatment. Behavioral and electrophysiological tests were conducted and the effect of the combined C16+Ang-1 treatment on neural function recovery was determined. We found that C16+Ang-1 treatment alleviated 3-NP-induced behavioral, biochemical, and cellular alterations in the central nervous system and promoted function recovery by restoring vascular permeability and reducing inflammation in the micro-environment. In conclusion, our results confirmed the neuroprotective effect of combined C16+Ang-1 treatment and suggest their potential as a complementary therapeutic against 3-NP-induced dystonia.
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Affiliation(s)
- Xiao-Xiao Fu
- Institute of Anatomy and Cell Biology and Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Hua-Ying Cai
- Department of Neurology, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Hong Jiang
- Department of Electrophysiology, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Shu Han
- Institute of Anatomy and Cell Biology and Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
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Subramani P, K S, B KR, R S, B.D P. Prediction of muscular paralysis disease based on hybrid feature extraction with machine learning technique for COVID-19 and post-COVID-19 patients. PERSONAL AND UBIQUITOUS COMPUTING 2021; 27:831-844. [PMID: 33679282 PMCID: PMC7926078 DOI: 10.1007/s00779-021-01531-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/27/2021] [Indexed: 05/26/2023]
Abstract
Many Coronavirus disease 2019 (COVID-19) and post-COVID-19 patients experience muscle fatigues. Early detection of muscle fatigue and muscular paralysis helps in the diagnosis, prediction, and prevention of COVID-19 and post-COVID-19 patients. Nowadays, the biomedical and clinical domains widely used the electromyography (EMG) signal due to its ability to differentiate various neuromuscular diseases. In general, nerves or muscles and the spinal cord influence numerous neuromuscular disorders. The clinical examination plays a major role in early finding and diagnosis of these diseases; this research study focused on the prediction of muscular paralysis using EMG signals. Machine learning-based diagnosis of the diseases has been widely used due to its efficiency and the hybrid feature extraction (FE) methods with deep learning classifier are used for the muscular paralysis disease prediction. The discrete wavelet transform (DWT) method is applied to decompose the EMG signal and reduce feature degradation. The proposed hybrid FE method consists of Yule-Walker, Burg's method, Renyi entropy, mean absolute value, min-max voltage FE, and other 17 conventional features for prediction of muscular paralysis disease. The hybrid FE method has the advantage of extract the relevant features from the signals and the Relief-F feature selection (FS) method is applied to select the optimal relevant feature for the deep learning classifier. The University of California, Irvine (UCI), EMG-Lower Limb Dataset is used to determine the performance of the proposed classifier. The evaluation shows that the proposed hybrid FE method achieved 88% of precision, while the existing neural network (NN) achieved 65% of precision and the support vector machine (SVM) achieved 35% of precision on whole EMG signal.
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Affiliation(s)
- Prabu Subramani
- Department of Electronics and Communication Engineering, Mahendra Institute of Technology, Namakkal, Tamil Nadu India
| | - Srinivas K
- Department of Computer Science and Engineering, CMR Technical Campus, Kandlakoya, Hyderabad, India
| | - Kavitha Rani B
- Department of Computer Science and Engineering, CMR Technical Campus, Kandlakoya, Hyderabad, India
| | - Sujatha R
- Department of Embedded Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Parameshachari B.D
- Department of Telecommunication Engineering, GSSS Institute of Engineering and Technology for Women, Mysuru, India
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Can We Put Aside Microelectrode Recordings in Deep Brain Stimulation Surgery? Brain Sci 2020; 10:brainsci10090571. [PMID: 32825301 PMCID: PMC7564183 DOI: 10.3390/brainsci10090571] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022] Open
Abstract
Microelectrode recording (MER) in deep brain stimulation (DBS) surgery has long been a recognized and efficient method for defining a target. However, in recent decades, imaging techniques, including DBS surgery, have experienced significant growth. There is convincing evidence that imaging-guided surgery can be helpful for targeting anatomically well-defined nuclei (e.g., subthalamic nucleus (STN) or internal globus pallidus (GPi)), and reductions in secondary effects have also been claimed. It has even been proposed that MER is not necessary to perform DBS, identifying in this way asleep surgery and imaging-guided DBS. However, there are several reasons why this is not the case. Neurophysiological techniques can efficiently and safely help to identify neural structures even in sleeping patients (e.g., different types of evoked potentials or motor stimulation). Deep nuclei are not homogeneous structures (even STN), so it is important to identify different places inside the putative target. Evidently, this is more relevant in the case of thalamic or hypothalamic surgery. Moreover, it is important to remember that the clinical and scientific knowledge acquired during DBS surgery can be important to gain further insight into pathologies and develop more effective treatments. Finally, the cost/efficiency of medical technology should be considered.
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Gupta N, Pandey S. Rest tremor in dystonia: epidemiology, differential diagnosis, and pathophysiology. Neurol Sci 2020; 41:2377-2388. [PMID: 32328831 DOI: 10.1007/s10072-020-04402-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The most common type of tremor reported in dystonia patients is postural and kinetic. There is uncertainty regarding the prevalence of rest tremor in dystonia. OBJECTIVE This review focuses on the clinical and neurophysiological features of rest tremor in dystonia, its differential diagnosis, and methods to distinguish it from other rest tremor syndromes. METHODS A PubMed search was done, and the available literature identified. Bibliography of the available literature was reviewed for relevant references. RESULTS Rest tremor in dystonia has been reported with a variable frequency of 1.81-12.05%. The most common body distribution is arm, and it tends to be asymmetric. Most of the affected patients have multifocal and segmental dystonia. Rest tremor is a late-onset phenomenon associated with severe and spreading dystonia. Clinically, it is difficult to distinguish rest tremor in dystonia from other rest tremor syndromes based on tremor characteristics; however, other neurological signs can provide clues to differentiate these syndromes. Surface electromyography and other neurophysiological tests can help differentiate the various rest tremor syndromes. CONCLUSION Rest tremor in dystonia can be differentiated from other rest tremor syndromes based on neurophysiological techniques. There is some evidence to suggest that SWEDDs could be a form of dystonic tremor, but further studies are required to clarify this diagnostic dilemma. Data regarding the treatment of rest tremor in dystonia are virtually nonexistent, and there is an urgent need for prospective studies focusing its medical management and to know the surgical targets.
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Affiliation(s)
- Navnika Gupta
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, Academic Block, Room No. 503, New Delhi, 110002, India.,University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, Academic Block, Room No. 503, New Delhi, 110002, India.
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Greene DJ, Marek S, Gordon EM, Siegel JS, Gratton C, Laumann TO, Gilmore AW, Berg JJ, Nguyen AL, Dierker D, Van AN, Ortega M, Newbold DJ, Hampton JM, Nielsen AN, McDermott KB, Roland JL, Norris SA, Nelson SM, Snyder AZ, Schlaggar BL, Petersen SE, Dosenbach NUF. Integrative and Network-Specific Connectivity of the Basal Ganglia and Thalamus Defined in Individuals. Neuron 2020; 105:742-758.e6. [PMID: 31836321 PMCID: PMC7035165 DOI: 10.1016/j.neuron.2019.11.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/28/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
The basal ganglia, thalamus, and cerebral cortex form an interconnected network implicated in many neurological and psychiatric illnesses. A better understanding of cortico-subcortical circuits in individuals will aid in development of personalized treatments. Using precision functional mapping-individual-specific analysis of highly sampled human participants-we investigated individual-specific functional connectivity between subcortical structures and cortical functional networks. This approach revealed distinct subcortical zones of network specificity and multi-network integration. Integration zones were systematic, with convergence of cingulo-opercular control and somatomotor networks in the ventral intermediate thalamus (motor integration zones), dorsal attention and visual networks in the pulvinar, and default mode and multiple control networks in the caudate nucleus. The motor integration zones were present in every individual and correspond to consistently successful sites of deep brain stimulation (DBS; essential tremor). Individually variable subcortical zones correspond to DBS sites with less consistent treatment effects, highlighting the importance of PFM for neurosurgery, neurology, and psychiatry.
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Affiliation(s)
- Deanna J Greene
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Scott Marek
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Evan M Gordon
- VISN17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA; Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Joshua S Siegel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Caterina Gratton
- Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Neurology, Northwestern University, Evanston, IL, USA
| | - Timothy O Laumann
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Adrian W Gilmore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey J Berg
- Department of Psychology, New York University, New York, NY, USA
| | - Annie L Nguyen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dillan J Newbold
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacqueline M Hampton
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley N Nielsen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Kathleen B McDermott
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Psychological and Brain Sciences, Washington University, St. Louis, MO, USA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven M Nelson
- VISN17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA; Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven E Petersen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Nico U F Dosenbach
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA; Program in Occupational Therapy, Washington University, St. Louis, MO, USA.
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Park HE, Shin MJ, Lee JS, Shin YB. Pharyngeal Dystonia Misdiagnosed as Cricopharyngeal Dysphagia Successfully Treated by Pharmacotherapy. Ann Rehabil Med 2020; 43:720-724. [PMID: 31918534 PMCID: PMC6960087 DOI: 10.5535/arm.2019.43.6.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/28/2018] [Indexed: 11/23/2022] Open
Abstract
A 43-year-old woman suffered from drooling and dysphagia after a stroke in the left posterior inferior cerebellar artery territory. Videofluoroscopic swallowing study showed compatible findings of cricopharyngeal dysphagia. Despite the injection of botulinum neurotoxin, no symptom improvement was achieved and pharyngeal dystonia was considered as the cause. Medications for dystonia dramatically helped with saliva control and resulted in a small improvement in the progression of food from the pharyngeal to esophageal phase. After adjusting the drug dose, the patient was able to perform social activities without drooling. Moreover, she could consume food orally; however, this was limited to small amounts of liquid, and the main method of nutrition support was via an orogastric tube. Therefore, we suggest that physicians should make a differential diagnosis of combined dystonia in patients complaining of dysphagia by esophageal manometry and electromyography.
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Affiliation(s)
- Ho Eun Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine-Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Myung Jun Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine-Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Je-Sang Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine-Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine-Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Núñez Medrano JA, Fernández E, Georgescu D, Díaz Díaz AL, Graue Moreno G. Consensus of the Iberoamerican Oculoplastic Society for diagnosis and management of facial dystonia. ACTA ACUST UNITED AC 2019; 94:436-440. [PMID: 31272707 DOI: 10.1016/j.oftal.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. MATERIAL AND METHODS An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. CONCLUSIONS Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease.
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Affiliation(s)
| | - E Fernández
- Práctica particular, Palma de Mallorca, España
| | - D Georgescu
- Práctica particular, Estados Unidos de América
| | | | - G Graue Moreno
- Departamento de Órbita y Oculoplástica, Hospital Nuestra Señora de la Luz, Ciudad de México, México
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Shin SW, Lee JS, Abdi S, Lee SJ, Kim KH. Antipsychotics for patients with pain. Korean J Pain 2019; 32:3-11. [PMID: 30671198 PMCID: PMC6333575 DOI: 10.3344/kjp.2019.32.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/19/2023] Open
Abstract
Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (α), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak D2 receptor bindings with strong binding to the 5-HT2A receptor, while typical antipsychotics block long-lasting, tight D2 receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.
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Affiliation(s)
- Sang Wook Shin
- Department of Anesthesia and Pain Medicine, Pusan National University, Busan, Korea
| | - Jin Seong Lee
- Department of Psychiatry, Pusan National University, Busan, Korea
| | - Salahadin Abdi
- Department of Pain Medicine, Division of Anesthesia and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Su Jung Lee
- Department of Anesthesia and Pain Medicine, Pusan National University, Busan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, Pusan National University, Busan, Korea
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Elkaim LM, De Vloo P, Kalia SK, Lozano AM, Ibrahim GM. Deep brain stimulation for childhood dystonia: current evidence and emerging practice. Expert Rev Neurother 2018; 18:773-784. [DOI: 10.1080/14737175.2018.1523721] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lior M. Elkaim
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Phillippe De Vloo
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada
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15
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Navrotchi C, Badea ME. The influence of occlusal stabilization appliances on cervical dystonia symptoms. Med Pharm Rep 2017; 90:438-444. [PMID: 29151795 PMCID: PMC5683836 DOI: 10.15386/cjmed-824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/15/2017] [Accepted: 08/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to assess the therapeutic efficiency of the occlusal stabilization appliance (OSA) in patients with cervical dystonia (CD). Methods The study included 11 patients aged between 29 and 80 years, 7 women and 4 men, diagnosed with primary CD. The patients underwent an extra- and intra-oral clinical examination, followed by para-clinical examinations, necessary for the specifications of the OSA. The following data were recorded: demographic parameters, CD duration, management of the disease, dental impression, recording of the centric relationship, recording of the position of the upper jaw with the facial bow. A standardized OSA was manufactured in a private dental laboratory. Patients received instructions for wearing the OSA for 24 hours. Patients filled a questionnaire designed by us, which evaluated the effects of wearing the OSA over a 24-hours period on the symptoms of CD: muscles contraction, pain, discomfort while walking, sleep quality, tremor. The patients kept the dental appliances, and after three months they completed the questionnaire one more time. Results The OSA was applied on the lower arch in 3 (27.3%) patients and on the upper arch in 8 (72.7%) patients. The OSA wearing time for the first 24 h was on average 19.2±6 hours. Total relaxation of dystonic muscles was reported by 9 (81.8%) patients, while 2 (18.2%) patients related partial muscle relaxation. Seven (63.6%) patients reported a pain decrease. Increased comfort while walking was observed by 8 (72.7%) patients. Two (18.2%) patients described an increase of sleep quality. In two (18.2%) patients the tremor disappeared. All patients reported difficulties while eating and removed the OSA during meals. Patients who wore the OSA for more hours, experienced a pain decrease (p=0.08), an increase in sleep quality (p=0.1), the disappearance of the tremor (p=0.1). After three months, only seven patients continued to use the OSA. More patients described a pain decrease after three months (5 (71.4%) vs. 4 (57.1%); p=0.5), relaxation of dystonic muscles (7 (100%) vs. 6 (85.7%); p=0.3). Conclusions The use of OSA might be beneficial in CD patients, as it reduced the dystonic symptoms, pain severity and improved the quality of sleep.
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Affiliation(s)
- Camelia Navrotchi
- Department of Preventive Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mîndra Eugenia Badea
- Department of Preventive Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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16
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Abstract
Objective To examine whether or not an edrophonium challenge test is useful for diagnosing cervical dystonia. Patients We evaluated 10 patients with cervical dystonia and 10 with hemifacial spasms (disease controls). We administered edrophonium and saline in this double-blinded study. Before and after the injection, we recorded the participants' clinical signs using a video camera to assess the objective symptoms every two minutes. Ten minutes after the saline and edrophonium injections, participants evaluated their subjective clinical signs using a visual analog scale. The objective signs on the video recordings were scored by specialists who were blinded to the treatment. The mean visual analog scale scores were compared using the Wilcoxon rank-sum test for paired continuous variables. Results The clinical signs of participants with cervical dystonia were amplified by edrophonium. In contrast, the clinical signs in participants with hemifacial spasms were not affected by the edrophonium challenge test. Conclusion The edrophonium challenge test may be useful for diagnosing cervical dystonia.
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Affiliation(s)
| | - Nagahisa Murakami
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Hidetaka Koizumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | | | - Yuishin Izumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
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Hintze JM, Ludlow CL, Bansberg SF, Adler CH, Lott DG. Spasmodic Dysphonia: A Review. Part 1: Pathogenic Factors. Otolaryngol Head Neck Surg 2017; 157:551-557. [PMID: 28850801 DOI: 10.1177/0194599817728521] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The purpose of this review is to describe the recent advances in identifying possible factors involved in the pathogenesis of spasmodic dysphonia. Spasmodic dysphonia is a task-specific focal laryngeal dystonia characterized by irregular and uncontrolled voice breaks. Pathogenesis of the disorder is poorly understood. Data Sources PubMed, Google Scholar, and Cochrane Library. Review Methods The data sources were searched using the following search terms: ( spasmodic dysphonia or laryngeal dystonia) and ( etiology, aetiology, diagnosis, pathogenesis, or pathophysiology). Conclusions Several potential etiological factors have been proposed by epidemiological, genetic, and neuropathological studies. Spasmodic dysphonia is a rare disorder primarily affecting females beginning in their 40s. Vocal tremor co-occurs in 30% to 60%. Large cohort studies identified risk factors such as a family history of neurological disorders including dystonia and tremor, recent viral illness, and heavy voice use. As none are rare events, a complex interactive process may contribute to pathogenesis in a small proportion of those at risk. Consequences to pathogenesis are neurological processes found in spasmodic dysphonia: loss of cortical inhibition, sensory processing disturbances, and neuroanatomical and physiological differences in the laryngeal motor control system. Implications for Practice Diagnosis of spasmodic dysphonia usually includes speech and laryngoscopic assessment. However, as diagnosis is sometimes problematic, measurement of neurophysiological abnormalities may contribute useful adjuncts for the diagnosis of spasmodic dysphonia in the future.
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Affiliation(s)
- Justin M Hintze
- 1 Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Christy L Ludlow
- 2 Department of Communication Sciences and Disorders, James Madison University, Virginia, USA
| | - Stephen F Bansberg
- 3 Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Charles H Adler
- 4 Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David G Lott
- 1 Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.,3 Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Piovesana LG, Torres FR, Azevedo PC, Amaral TP, Lopes-Cendes I, D'Abreu A. New THAP1 mutation and role of putative modifier in TOR1A. Acta Neurol Scand 2017; 135:183-188. [PMID: 26940431 DOI: 10.1111/ane.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The prevalence of DYT1 (mutation in TOR1A) and DYT6 (mutation in THAP1) may vary in different populations, which can have important implications in clinical investigation. Our goal was to characterize patients with inherited and isolated dystonia and determine the frequency of mutations responsible for DYT1 and DYT6 in Brazilian patients. METHODS Two movement disorder specialists examined 78 patients with idiopathic isolated dystonia using a standardized questionnaire, before sequencing TOR1A and THAP1 genes. RESULTS Clinically, our cohort was similar to those described in the international literature. Molecular studies of 68 subjects revealed only one potentially deleterious variant in THAP1 (1/68 patients, 1.47%). This was a novel 10-bp deletion at the end of exon 1, g.5308_5317del (ng_011837.1), which is predicted to create an alternative splicing and the insertion of a premature stop codon. Although we did not observe any potentially deleterious mutations in TOR1A, we found the missense variant rs1801968 (TOR1A p.D216H), previously reported as either a modifier of dystonia phenotype or a predisposing factor for dystonia. However, we did not identify any phenotypic impact related to the missense variant rs1801968 (P = 0.3387). CONCLUSIONS Although clinically similar to most cohorts with dystonia worldwide, the classical mutation (c.907_909delGAG) in TOR1A (causing DYT1) is absent in our patients. However, we found a potentially deleterious THAP1 mutation not previously reported. In addition, we found no association of rs1801968 with dystonia.
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Affiliation(s)
- L. G. Piovesana
- Department of Neurology; University of Campinas (UNICAMP); Campinas SP Brazil
| | - F. R. Torres
- Department of Medical Genetics; University of Campinas (UNICAMP); Campinas SP Brazil
| | - P. C. Azevedo
- Department of Neurology; University of Campinas (UNICAMP); Campinas SP Brazil
| | - T. P. Amaral
- Department of Medical Genetics; University of Campinas (UNICAMP); Campinas SP Brazil
| | - I. Lopes-Cendes
- Department of Medical Genetics; University of Campinas (UNICAMP); Campinas SP Brazil
| | - A. D'Abreu
- Department of Neurology; University of Campinas (UNICAMP); Campinas SP Brazil
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Electrophysiological interpretations of the clinical response to stimulation parameters of pallidal deep brain stimulation for cervical dystonia. Acta Neurochir (Wien) 2016; 158:2029-38. [PMID: 27562682 DOI: 10.1007/s00701-016-2942-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/17/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) at the posterolateral ventral portion of the globus pallidus internus (GPi) has been regarded as a good therapeutic modality. Because the theoretical principle behind the stimulation parameters is yet to be determined, this study aimed to interpret analyses of the stimulation parameters used in our department based on an electrophysiological review. METHODS Nineteen patients with medically refractory idiopathic cervical dystonia who underwent GPi DBS were enrolled. The baseline and follow-up parameters were analyzed according to their dependence on time after DBS. The pattern of changes in the stimulation parameters over time, the differences across the four active contacts, and the relationship between the stimulation parameters and clinical benefits were evaluated. RESULTS Mean age and disease duration were 50.9 years and 54.7 months, respectively. Mean follow-up duration was 22.6 months. The amplitude and frequency exhibited significant increasing temporal patterns, i.e., a mean amplitude and frequency of 3.1 V and 132.2 Hz at the initial setting and 4.0 V and 142.6 Hz at the last follow-up, respectively. The better clinical response group (clinical improvement rate of 65-100 %) used a narrower pulse width (mean value of 78.4 μs) than the worse clinical response group (clinical improvement rate of 5-60 %, mean of value of 88.6 μs). Active contact at the GPe was used more often in the worse clinical response group than in the better response group. CONCLUSIONS Based on electrophysiological considerations, these patterns of stimulation parameters could be interpreted. This interpretation was based on a theoretical understanding of the mechanisms of action of DBS, i.e., that the abnormal neural signal is substituted by an induced neural signal, which is generated by therapeutic DBS.
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Barbey A, Bloch J, Vingerhoets FJG. DBS in Dystonia and Other Hyperkinetic Movement Disorders. Curr Treat Options Neurol 2015; 17:373. [PMID: 26257150 DOI: 10.1007/s11940-015-0373-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT The diagnosis and appropriate treatment of hyperkinetic movement disorders require a work up of potentially reversible metabolic, infectious and structural disorders as well as side effects of current medication. In pharmacoresistant movement disorders with a disabling impact on quality of life, deep brain stimulation (DBS) should be considered. At different targets, DBS has become an established therapy for Parkinson's disease (GPi-STN), tremor (VIM) and primary dystonia (GPi) with reasonable perioperative risks and side effects, established guidelines and some clinical and radiological predictive factors. In contrast, for other hyperkinetic movement disorders, including secondary dystonia, Gilles de la Tourette, chorea and ballism, only few data are available. Definite targets are not well defined, and reported results are of less magnitude than those of the recognized indications. In this expanding therapeutical field without worked out recommendations, an individual approach is needed with DBS indication assessment only after rigorous multidisciplinary scrutiny, restricted to expert centres.
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Affiliation(s)
- A Barbey
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 21, CH-1011, Lausanne, Switzerland
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